The impact of performance feedback reports on physician ordering behavior in the use of computed tomography pulmonary angiography (CTPA)

Abstract

PurposeThe increased utilization, and potential overutilization, of computed tomography pulmonary angiography (CTPA) is a well-recognized issue within emergency departments (EDs). The objective of this study is to determine the impact of performance feedback reports on CTPA ordering behavior among ED physicians. Methods We conducted a prospective study of the impact of individualized performance feedback reports on the ordering behavior of physicians working at two high-volume community EDs in Ontario, Canada. We generated individualized reports (or "Dashboards") for each ED physician containing detailed feedback and peer comparison for each physician's CTPA ordering. Our baseline pre-intervention period was January 1 to December 31, 2018, and our intervention period was January 1, 2019, to December 31, 2021. We tracked individual and group ordering behavior through the study period. Our primary outcomes are impact of feedback on (1) overall group ordering rate and (2) overall diagnostic yield. Secondary analysis was done to determine the impact of the intervention on those physicians with the highest CTPA utilization rate. Results There was no statistically significant difference in the diagnostic yield of the included physicians in either of the years of the intervention period. There was a statically significant increase in the utilization rate for CTPA from 2018 to 2020 and 2021 from 5.9 to 7.9 and 11.4 CTPAs per 1000 ED visits respectively (p < 0.5). Conclusion Our study found no consistent significant impact of individualized feedback and peer comparison on physician ordering of CTPAs. This points to a potentially greater impact of environmental and institutional factors, as opposed to physician-targeted quality improvement measures, on physician ordering behavior.

Improving Adherence to Pulmonary Embolism Evaluation Consensus Guidelines: A Multimodal Approach

“…al nor Salehi et. al achieved significant increase in positivity rate through this intervention type alone 12,13 . However, one notable difference between these studies and ours, is that while our intervention provided only one-time feedback to providers, these studies provided periodic reports.…”

Audit and feedback to change diagnostic image ordering practices: A systematic review and meta-analysis

“…Eleven RCTs met the inclusion criteria from an initial literature search that identified 4493 papers ( Fig 1 ) [ 27 – 37 ]. One non-randomized controlled trial (NRCT) [ 38 ] and 5 observational studies were included in the Appendix (S1-S4 Tables and S1, S2 Figs in S1 Appendix ) [ 39 – 44 ]. All of these studies included at least one comparison that met our inclusion criteria.…”

Evaluating feedback reports to support documentation of veterans’ care preferences in home based primary care

“…Our process evaluation uncovered potential reasons for the failure of feedback reports to significantly increase LST template completion, including concerns shared by site champions that they worried sharing the reports would discourage staff because they felt the rate of LST template completion was low. Site champions also expressed concern that the feedback reports did not provide a complete picture of the effort to conduct goals of care conversations with inclusion of data only from prescribing providers and not for the non-prescribing provider template that is often used to inform LST template completion [ 21 , 22 ]. While stakeholders from HBPC programs were included in the design of the feedback reports, these concerns were not identified during the design process suggesting that iterative adaptation may be needed throughout the implementation period rather than isolating refinement to the pre-implementation period [ 6 ].…”